Working as a psychiatric trainee, further pregnancy, early loss, acute stress reaction. Back to work, pregnant again, passed Part 1 MRCPsych. Second daughter born.

Genealogical narratives often include a strand of violence and physical effort for women, particularly through childbirth but also through exile, migration for marriage, and establishing an independent life, as the previous chapters show. This chapter explores genealogical transmission and its relationship to violence and women’s action in the context of administrative communication networks in the Middle English Athelston, in which the king kicks his wife, killing his heir, and sentences his pregnant sister to a trial by fire. Drawing on network theory, which emphasizes the “doers” and “doing” of a network, the chapter explores the alignment of the two royal heir-bearers with messengers, which positions the women as key transmitters, not unlike the Virgin Mary at the Annunciation, rather than as wives who simply carry their husbands’ children. In this model of transmission, the women influence succession not only through childbearing but also through royal petitioning, letter writing, and prayer.

Women with uterine fibroids are more likely to have pregnancies complicated by fetal and maternal complications. Women should be counselled that the risks of obstetrical complications are increased with the presence of fibroids in pregnancy. There are still no adequate data on the optimum management strategy of fibroids in pregnancy. In women with prior myomectomy, a plan for labour and vaginal delivery is reasonable in those who did not have extensive myometrial dissection or entry into the endometrial cavity. Alternately, for those who choose an approach of scheduled Caesarean delivery, timing at 37–38 weeks’ gestation is reasonable.

While conception, pregnancy and childbirth are ‘natural’ events for most, for some the process is more complicated, medicalised, and marked by unexpected or difficult events. This chapter examines the experience of pregnancy when high investment is juxtaposed with high risk. The impact of a history of infertility, conception involving ART, pregnancy loss is examined in depth as well as evidence regarding the most effective ways to support parents who experience perinatnal loss.

Data from UK confidential enquiries suggest a declining rate of twin stillbirth in monochorionic (MC) and dichorionic (DC) twin pregnancies with improved outcomes possibly reflecting the establishment of national guidelines for the management of multiple pregnancies. Despite this, twin pregnancies are at greater risk of all pregnancy complications, miscarriage and stillbirth than singleton pregnancies. Monochorionic twins, comprising approximately 20% of twin pregnancies, are at particular risk of fetal loss due to the unique pathological complications of a shared placenta: Twin to Twin Transfusion Syndrome (TTTS), early-onset severe selective growth restriction (sGR) and twin anaemia polycythaemia sequence (TAPS). Furthermore, following single intrauterine fetal demise (sIUFD) surviving monochorionic co-twins are exposed to an increased risk of intrauterine death, neonatal death and neurological disability. This chapter examines single and double fetal loss in DC and MC twin pregnancies, outlining the key facts, and covering the difficult issues and management challenges posed by twin demise.

Loss of a pregnancy is undoubtedly an awful outcome that pregnant women dread. The question of whether sexual intercourse can cause pregnancy loss is a controversial and poorly studied topic. As recently as 40 years ago, sexual intercourse was listed in textbooks as a risk factor and precipitant for pregnancy loss. Most studies on this topic have a problematic methodology; in addition, many have selection biases and comprise a small number of subjects. In this chapter we review whether sex can result in miscarriage or stillbirth and whether women should refrain from having sex in order to prevent a pregnancy loss; when sexual intercourse can be resumed after a miscarriage; whether sex should be postponed after a miscarriage; and whether patients with a previous miscarriage should avoid sex in the current pregnancy.

The first trimester of pregnancy covers a major transition period for pregnant individuals and their partners. Sexual satisfaction, including in pregnancy, is an important facet of a fulfilling relationship. The frequency of sexual activity decreases during the first trimester and is accompanied by increased sexual dysfunction, particularly once the pregnancy is identified. This may be secondary to physical factors such as fatigue and nausea and vomiting as well as a fear of miscarriage or harm to the pregnancy. Sexual activity in the first trimester has not been demonstrated to result in miscarriage, adverse obstetric outcomes, or fetal harm. Vaginal bleeding may be associated with an increased risk of miscarriage and therefore caution is advisable for vaginal intercourse in these cases. Obstetric care providers can support couples in early pregnancy by including discussions of the safety of sexual activity, expectations during pregnancy, and alternative mechanisms of intimacy as part of routine pregnancy care.

Women over the age of 40 years are at a higher risk of early pregnancy complications such a miscarriage or ectopic pregnancy. They are also more likely to have pre-existing medical conditions which further increase their risk of early pregnancy pathology, for example, previous pelvic inflammatory disease leading to a tubal ectopic, or uncontrolled diabetes increasing the risk of a miscarriage. Women in this age group are also more likely to have conceived through fertility treatment, and may present with complications of this, such as multiple pregnancy or ovarian hyperstimulation syndrome. A woman’s history of assisted reproductive technology and pre-existing subfertility is significant not only in accurately dating the pregnancy but also with regards to the psychological impact in case of a poor outcome. Early pregnancy units have become well established in most hospitals as a dedicated department providing specialist early pregnancy care. This chapter provides an overview of the optminal management of the first trimester of pregnancy for women over 40 and the management of the common conditions.

Acute gynaecological emergencies are conditions of the female reproductive system that threaten the woman’s life, her sexual function or her fertility. Common gynaecological emergencies present as acute abdomen, abnormal vaginal bleeding, or a combination of both.

The main gynaecological emergencies could be divided into early pregnancy problems, gynaecologic causes of severe pelvic pain (acute pelvic inflammatory disease, pelvic endometriosis, torsion and rupture of an ovarian neoplasm, torsion or degeneration of a uterine leiomyoma, ovarian hyperstimulation syndrome), severe vaginal bleeding, vulvar abscesses, toxic shock syndrome and sexual violence.

Abortion. The phrase “uterine evacuation” can create tension and line people up on opposite sides of the abortion issue, with no recognition of its safety, commonplace occurrence and health or life-saving capabilities. Due to the dichotomized and politicized nature of abortion, in some places it is difficult to teach health care providers how to empty a uterus, even in a life-threatening situation.Early pregnancy loss (EPL) management can provide an entry point for this education, as well as a way to destigmatize the uterine aspiration procedure and medical treatment because, although management is the same as for “elective abortion” the indication is different; with an abortion, a pregnancy is terminated that would otherwise likely continue, while with EPL, the pregnancy has ceased to be viable. This difference is subtle, yet concrete and profound for many.

Miscarriage and stillbirth are not rare events and losing a baby can have an overwhelming and long-term impact on parents, on existing and subsequent children and on wider family. Potential parents’ feelings of devastation, intense grief, anxiety, guilt and self-blame and loss following such a death have been identified in literature written over past centuries. Fifty years ago, miscarriage and stillbirth were a private matter and unspoken of, leaving parents to manage their grief alone. This chapter aims to shine a light on the changes in attitudes and the support available to those who have experienced miscarriage and perinatal death since the 1960s. A review of relevant research, policy and practice identified significant advances in medical science and major changes to the law – changes that have influenced attitudes to abortion, same-sex parenthood and single mothers. Medical advances have made childbirth safer and the use of IVF has extended the opportunity of motherhood to a wider group of women. The campaigning of numerous charities has led to far greater understanding of the impact of baby loss on parental mental health and parenting capacity.

In Broadnax v. Gonzalez the court overruled precedent that denied pregnant women tort recovery when negligent prenatal care caused miscarriage or stillbirth. The decision held that doctors owe a direct duty of care to the pregnant patient that permits her to recover for the emotional harm from pregnancy loss. The rewritten feminist opinion comes to the same conclusion, but more thoroughly critiques the prior cases as treating women as separate from their fetuses, virtual bystanders to their own bodies. It also concludes that miscarriage or stillbirth harms women physically, not just emotionally, and that tort law should treat these cases like any other medical malpractice case. The accompanying commentary explores the conflicting ways courts have categorized women’s harm to limit recovery for prenatal malpractice, and argues that greater attention to women’s experience of pregnancy complications and harm loss would improve both medical outcomes and the gender equity of tort law.

There is a pattern to how pregnancy is theatrically represented in Ireland: It is a taboo, a silence, an open secret. This is symptomatic of the Irish social and cultural stigmatization of women’s bodies and part of a larger discourse in which women’s bodies are carefully policed to be visible but inarticulate and assumed to be usable but unintelligible. This chapter considers new performances of pregnancy, maternity, and non-maternity on the Irish stage as a way of troubling the assumption that women’s bodies are invisible or inappropriate in contemporary theatre, in plays by ANU Productions, Bump & Grind, Stacey Gregg, Elaine Murphy, Frank McGuinness, Christian O’Reilly, and THEATREClub.